Providers would be overburdened by Medicare overpayment rule, expert notes

A proposed rule that would require Medicare providers to return overpayments within 60 days of detection could significantly increase administrative time and costs, an expert says.

The Centers for Medicare & Medicaid Services in Februaryproposed a rule mandating that providers report and return overpayments of Medicare Part A and Part B. Medicare Part A pays for short-term stays in skilled nursing and rehabilitation facilities.

But the rule is not consistent with providers' expectations, attorney Robert L. Roth said in a Bureau of National Affairs webinar this week. He said the regulation contains a 10-year look-back period that CMS picked because it's on the outer limit of the federal False Claims Act statute of limitations.

“The 10-year standard inappropriately links simple payment errors with the FCA liability standard, which is intended for intentional fraud,” Roth said in the webinar.

Under the rule, providers must specify to CMS why the overpayment went through, within 60 days of identifying it. Failing to do so beyond the 60-day limit would create a FCA obligation and incur a $10,000 fine for each overpayment.

About 60,000 elderly or disabled Medicaid recipients in Louisiana are being told they should expect to lose their benefits in July, and advocates say more than a quarter of them could be forced out of the long-term care facilities they call home.